Healthcare Provider Details

I. General information

NPI: 1467923326
Provider Name (Legal Business Name): ADVANCED BEHAVIOR HEALTH ANALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MIRACLE STRIP PKWY STE 503
MARY ESTHER FL
32569-1991
US

IV. Provider business mailing address

2914 BENTWOOD LN
FORT WALTON BEACH FL
32547-6855
US

V. Phone/Fax

Practice location:
  • Phone: 252-529-9259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE GRACELA WEBB
Title or Position: OWNER
Credential: LMHC, BCBA
Phone: 252-529-9259